Occupational, Physical, and Speech-Language Therapy

The hospice benefit specifically provides occupational therapy
services, physical therapy services, and speech-language therapy
services for those hospice patients that would benefit from such
therapy. Simply having a terminal illness does not mean that we
have to "give up" and lay down in bed and immediately
die, as some may erroneously believe. Those patients who make the
most of their remaining time usually experience the highest
quality of life. Hospice is about improving the quality of life
and providing comfort care, even if a "cure" for the
disease cannot be made. What benefit would these therapies have
for your loved one? Many. First of all, these therapists are
highly trained specialists in their field and can determine what
interventions can help improve your loved one's quality of
life!

Occupational Therapy

An Occupational Therapist can evaluate the ability of your
loved one to accomplish his activities of daily living ... to do
the normal everyday tasks that are commonly performed, such as
bathing, getting dressed, brushing his teeth, and feeding
himself, etc. If there are difficulties in performing these types
of tasks, the therapist can devise alternative ways of
accomplishing these tasks which allow the patient to remain more
independent (and less dependent upon others) which can often help
tremendously with the patient's self-esteem and attitude.

Sometimes different adaptive or assistive devices are used to
help patients accomplish these tasks. The therapist can explain
how your loved one can conserve his energy by doing things in an
easier manner. Helping your loved one continue to do as much as
possible (if he or she wishes to do so) can dramatically improve
his quality of life.

Physical Therapy

The physical therapist can evaluate your loved one's
ability to move around safely in the home or facility. The
therapist will determine what problems your loved one may be
experiencing in getting around: walking (if applicable), in and
out of bed, transfer from chair to bed, into the bathroom, to and
from a car or wheelchair. The therapist can assess the
patient's level of pain and provide physical therapies which
can help to reduce pain. Strengthening exercises may be given if
your loved one would benefit from these, and the therapist can
evaluate all the equipment or layout of your loved one's
living situation to make it safe and easily accessible.

Speech-Language Therapy

The speech language therapist is especially trained in helping
your loved one who might be experiencing difficulties in
swallowing food, speaking or communicating in any way. The
therapist can help the patient to better communicate and
determine what types of foods or food textures are best. For
example, some patients who have difficulty swallowing can safely
swallow soft or blended foods or foods cooked in different ways.
Making sure that your loved one is able to overcome swallowing
problems could help your loved one live longer and would
certainly improve his quality of life! If your loved one had
difficulty speaking or could no longer speak at all, the
therapist can help create alternative ways of communicating.
Communication between the family members and the hospice patient
is so important at the end of life. Unfinished family
"business" (relationship issues) can be resolved and
your love can be expressed and shared.

Warning about Lack of Therapy Services

Ethical hospices will definitely provide these types of very
important services to their patients. The RN case manager will
make a referral to the therapists to come out and assess the
patient's situation and to determine what therapy might be
beneficial for your loved one. However, you should be aware
that there are many hospices that do not properly inform the
patient about these services and simply do not provide them, or
actually misinform the patients and families by stating that
these types of services are not part of the hospice benefit!
We have gotten repeated complaints here at Hospice Patients
Alliance, from families who reported having been told by hospice
staff that these services were not available and not part of
hospice. These therapy services are part of the hospice
benefit!

Federal Law Requiring Provision of Therapy Services

The following is the exact language of the federal law
governing hospice care at the Code of Federal Regulations, 42 CFR
ch. iv. part 418:

(a) Physical therapy services, occupational therapy
services, and speech-language pathology services must be
available, and when provided, offered in a manner consistent with
accepted standards of practice.????[emphasis added]

If you have difficulty obtaining these types of services for
your loved one, simply print out this page and show it to your RN
case manager. If they still refuse to provide therapy services,
you can speak with the hospice director or file a complaint with
your State licensing and certification department.